Automated assessment and adjustment of tinnitus-masker impact on speech intelligibility during use

ABSTRACT

Disclosed herein, among other things, are apparatus and methods for automated assessment and adjustment of tinnitus-masker impact on speech intelligibility during use of the tinnitus-masker. In various embodiments, a method of fitting a tinnitus-masker device for a patient is provided. The method includes using a speech intelligibility model to predict impact of therapy provided by the tinnitus-maker device on speech understanding of the patient. A parameter of the tinnitus-masker device is automatically adjusted during use to reduce the impact of the therapy provided by the tinnitus-maker device on speech understanding of the patient, according to various embodiments.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 15/475,965, entitled “AUTOMATED ASSESSMENT AND ADJUSTMENT OFTINNITUS-MASKER IMPACT ON SPEECH INTELLIGIBILITY DURING FITTING”, filedon Mar. 31, 2017, which is hereby incorporated by reference herein inits entirety.

TECHNICAL FIELD

This document relates generally to hearing assistance systems and moreparticularly to automated assessment and adjustment of tinnitus-maskerimpact on speech intelligibility during use.

BACKGROUND

Hearing assistance devices, such as hearing aids, are used to assistpatients suffering hearing loss by transmitting amplified sounds to earcanals. In one example, a hearing aid is worn in and/or around apatient's ear.

Tinnitus is a condition in which a patient perceives sound in their earin the absence of corresponding external sound. While ringing of theears is associated with tinnitus, other types of sounds can be perceivedand can be sporadic, intermittent or continuous. Tinnitus can be causedby a number of conditions or injuries, but regardless of cause can bedebilitating and decrease a patient's quality of life. A tinnitus-maskeris a function of a hearing assistance device that can be used to providetherapy to a patient suffering from tinnitus.

There is a need in the art for improved mitigation of tinnitus-maskerimpact on speech intelligibility.

SUMMARY

Disclosed herein, among other things, are apparatus and methods forautomated assessment and adjustment of tinnitus-masker impact on speechintelligibility during use. In various embodiments, a method of fittinga tinnitus-masker device for a patient is provided. The method includesusing a speech intelligibility model to predict impact of therapyprovided by the tinnitus-maker device on speech understanding of thepatient. A parameter of the tinnitus-masker device is automaticallyadjusted during use to reduce the impact of the therapy provided by thetinnitus-maker device on speech understanding of the patient, accordingto various embodiments.

Various aspects of the present subject matter include a tinnitus maskinghearing device for a patient. The device includes a sound generatorconfigured to provide tinnitus masking therapy, and a processorconnected to the sound generator. In various embodiments, the processoris programmed with instructions to perform a method of using thetinnitus masking hearing device. A speech intelligibility model is usedto compute a first speech intelligibility score for speech without atinnitus masking therapy provided by the tinnitus masking hearingdevice. The speech intelligibility model is used to compute a secondspeech intelligibility score for speech with the tinnitus maskingtherapy provided by the tinnitus masking hearing device. A difference iscomputed between the first speech intelligibility score and the secondspeech intelligibility score. If the difference exceeds a programmablethreshold, a parameter of the tinnitus-masker device is adjusted toreduce the impact of the therapy provided by the tinnitus-maker deviceon speech understanding of the patient, in various embodiments.

Various aspects of the present subject matter include a non-transitorycomputer-readable storage medium that stores instructions for executionby processing circuitry of a tinnitus masking hearing device for apatient. The operations include using a speech intelligibility model tocompute a first speech intelligibility score for speech without atinnitus masking therapy provided by the tinnitus masking hearingdevice, and using the speech intelligibility model to compute a secondspeech intelligibility score for speech with the tinnitus maskingtherapy provided by the tinnitus masking hearing device. The operationsfurther include computing a difference between the first speechintelligibility score and the second speech intelligibility score, and,if the difference exceeds a programmable threshold, adjusting aparameter of the tinnitus-masker device to reduce the impact of thetherapy provided by the tinnitus-maker device on speech understanding ofthe patient, in various embodiments

This Summary is an overview of some of the teachings of the presentapplication and not intended to be an exclusive or exhaustive treatmentof the present subject matter. Further details about the present subjectmatter are found in the detailed description and appended claims. Thescope of the present invention is defined by the appended claims andtheir legal equivalents.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments are illustrated by way of example in the figures ofthe accompanying drawings. Such embodiments are demonstrative and notintended to be exhaustive or exclusive embodiments of the presentsubject matter.

FIG. 1 illustrates a block diagram of a system for limitingtinnitus-masker impact on speech intelligibility, according to variousembodiments of the present subject matter.

FIG. 2 illustrates a block diagram of a system for programming orfitting a hearing assistance device such as a tinnitus-masker, accordingto various embodiments of the present subject matter.

FIG. 3 illustrates a table showing levels of tinnitus masking and speechat select frequencies, according to various embodiments of the presentsubject matter.

FIG. 4 illustrates a flow diagram of a method for fitting atinnitus-masker for a patient, according to various embodiments of thepresent subject matter.

FIG. 5 illustrates a flow diagram of a method for automated assessmentand adjustment of tinnitus-masker impact on speech intelligibilityduring fitting, according to various embodiments of the present subjectmatter.

FIG. 6 illustrates a block diagram of system for limitingtinnitus-masker impact on speech intelligibility during use of thetinnitus-masker, according to various embodiments of the present subjectmatter.

FIG. 7 illustrates a flow diagram of a method for automated assessmentand adjustment of tinnitus-masker impact on speech intelligibilityduring use, according to various embodiments of the present subjectmatter.

DETAILED DESCRIPTION

The following detailed description of the present subject matter refersto subject matter in the accompanying drawings which show, by way ofillustration, specific aspects and embodiments in which the presentsubject matter may be practiced. These embodiments are described insufficient detail to enable those skilled in the art to practice thepresent subject matter. References to “an”, “one”, or “various”embodiments in this disclosure are not necessarily to the sameembodiment, and such references contemplate more than one embodiment.The following detailed description is demonstrative and not to be takenin a limiting sense. The scope of the present subject matter is definedby the appended claims, along with the full scope of legal equivalentsto which such claims are entitled.

The present detailed description will discuss hearing assistance devicesusing the example of hearing aids with tinnitus-maskers. Other hearingassistance devices include, but are not limited to, those in thisdocument. It is understood that their use in the description is intendedto demonstrate the present subject matter, but not in a limited orexclusive or exhaustive sense.

Tinnitus is a condition in which a patient perceives sound in their earin the absence of corresponding external sound. While ringing of theears is associated with tinnitus, other types of sounds can be perceivedand can be sporadic, intermittent or continuous. Tinnitus can be causedby a number of conditions or injuries, but regardless of cause can bedebilitating and decrease a patient's quality of life.

A common clinical solution for tinnitus involves listening to acontinuous sound, aka ‘tinnitus-masker’, generated by a hearing aid orby some other device. The overall volume and in some cases the spectralshape of the masker are adjusted individually based on the patient'saudiometric characteristics and/or listening preferences. In selectingthese parameters, an important consideration is that the tinnitus maskerdoes not interfere with the perception of external sounds of interest,such as speech. The present subject matter facilitates the selection ofa tinnitus-masker that does not interfere substantially with theperception of speech. In various embodiments, this is achieved by usinga speech-intelligibility model to automatically computespeech-intelligibility scores for different candidate tinnitus-maskers,and automatically adjusting the masker overall level and/or spectrum tokeep the speech-masking effect under some pre-defined level.

Adjustment During Fitting

Wearers of hearing assistance devices undergo a process called “fitting”to adjust the hearing assistance device to their particular hearing anduse. In such fitting sessions a wearer may select one setting overanother. Other types of selections include changes in level, which canbe a preferred level. Hearing assistance device settings may beoptimized for a wearer through a process of patient interview and deviceadjustment.

Currently, clinicians who wish to offer their patients a tinnitus-maskeradjust parameters of the masker during fitting such that they areadapted to the individual. Minimally, the clinician adjusts the overalllevel, or volume, of the masker, so that the masker is neither toofaint, having no effect on tinnitus, or too loud to cause too muchmasking of relevant external sounds (such as speech). Clinicians mayalso adjust the spectrum, or level per frequency-band, of the masker,and possibly other parameters such as the modulation rate. In fitting atinnitus masker, an important consideration is that the selected maskerdoes not interfere with speech intelligibility. Previous tinnitus-maskergeneration systems do not include a mechanism for checking that theselected masker will not interfere with speech understanding. Thepresent subject matter includes a speech-intelligibility predictionstage in tinnitus-masker fitting software, and uses the results of thismodeling stage for automatically adjusting the overall level and/orspectrum of the tinnitus masker, so as to limit disruptions of speechunderstanding to a pre-defined level.

In various embodiments, the present subject matter uses a model ofspeech intelligibility (e.g., the speech-intelligibility index, or‘SII’), modified to account for hearing loss, to compute aspeech-intelligibility score for normal or conversational-level speechwith, and without, a tinnitus-masker. The difference between these twoscores is computed, and it is used to determine whether the tinnitusmasker is acceptable, or whether it is likely to disrupt speechintelligibility by more than a pre-defined acceptable amount, in variousembodiments.

In one embodiment, if the tinnitus-masker's impact on speechintelligibility is acceptably small, nothing is done. However, if thetinnitus-masker's impact on speech intelligibility is too large to beaccepted, an option is offered to the clinician to automatically adjustthe overall level or spectrum or other parameter of the tinnitus masker,so as to limit the impact of the tinnitus-masker on speechintelligibility to an acceptable level, in various embodiments. Infurther embodiments, the option could be offered to the patient, if thetinnitus-masker fitting is performed by the patient him or herself. Theadjustment of tinnitus masking parameters is done automatically, invarious embodiments.

FIG. 1 illustrates a block diagram of system for limitingtinnitus-masker impact on speech intelligibility, according to variousembodiments of the present subject matter. In various embodiments, thetinnitus-masker spectrum 102 as defined by the clinician or the patientis used as input, along with the patient's audiogram 104, to aspeech-audibility estimation model 106. Based on the results,speech-intelligibility scores 108 are computed for normal conversational(approximately 65 to 70 dB SPL) speech with, and without, the tinnitusmasker. If the speech-intelligibility score 108, or the speechaudibility, with the masker is too low taking into account thespeech-intelligibility score without the masker, an option is offered110 to automatically adjust the masker spectrum to limit the impact onspeech intelligibility, in various embodiments.

In various embodiments, the spectrum of the proposed tinnitus masker(M[f]) and pure-tone audiogram (T[f]) of the patient are input into aspeech-intelligibility model to estimate the audibility (A[f]) of anormal conversational (65 to 70 dB SPL) speech signal (S[f]) indifferent frequency bands (denoted by the index, f) with the tinnitusmasker (Am[f]) and without the tinnitus masker (An[f]). The computedaudibility data are used to compute a global speech-intelligibilityscore (SI) with the masker (SIm) and without the masker (SIn). These twoscores are used to compute a “corrected” score (SIc), as follows:Sic=Sim+g((1−SIn)*a), where a is a correction factor and g is anonlinear transformation function (e.g., a scaled sigmoid function), invarious embodiments.

According to various embodiments, if the corrected score (SIc) is lowerthan a predefined threshold (SIcrit), an option is offered to the userfor automatically adjusting the proposed tinnitus spectrum, so as tolimit the impact of the tinnitus masker on speech intelligibility.Formally, the adjusted tinnitus spectrum (Ma[f]) is computed as:

Ma[f]=M[f]−M[f]*h(1−z(Am[f],An[f],f))

where h and z are two non-linear functions. While the details of thesetwo functions may vary, generally the level of the tinnitus masker isreduced in a frequency-dependent manner, so that masker levels tend tobe more attenuated for frequency bands that contribute more to reducingspeech audibility/intelligibility than for frequency bands thatcontribute less to reducing speech audibility/intelligibility. Moreover,the function, z, includes a regularization term, whereby attenuationsapplied to adjacent frequency bands are coupled, or smoothed to avoidlarge differences in the attenuations applied across adjacent frequencybands, which could create undesirable artifacts related to the presenceof sharp spectral edges between adjacent bands.

In various embodiments, the computation of the predictedspeech-intelligibility score contains a so-called proficiency factor.This variable influences the shape of the relationship between thecomputed audibility of the speech signal and the predicted speechintelligibility. The selection of the proficiency factor can beadvantageously informed by the results of perceptual and/or cognitivetests, resulting in improved predictions of speech-intelligibilityscores for different types of speech materials in hearing-impairedlisteners—compared to predictions obtained without taking into accountsuch additional information. For example, thresholds for the detectionand/or discrimination of spectral, temporal, or spectro-temporalmodulation, or the measured completion time for a Trail-making B testobtained in a listener could be used to estimate the proficiency factorfor that listener.

Definition of variables:

f: frequency-band index

M[f]: level per band (dB SPL) of the proposed tinnitus masker

S[f]: average level per band (dB SPL) of a normal (65 to 70 dB SPL)speech signal

T[f]: pure-tone threshold (dB SPL)

FIG. 2 is a block diagram illustrating an embodiment of a hearingassistance system 210 for programming and/or fitting a hearingassistance device, such as a device with a tinnitus-masker. In theillustrated embodiment, system 210 includes a programmer or fittingdevice 212, a hearing assistance device 222, and a communication link220 providing for communication between programmer 212 and hearingassistance device 222. In various embodiments, programmer 212 andhearing assistance device 222 may each include one or more devices. Forexample, programmer 212 may include a computer or a computer connectedto a communicator, and hearing assistance device 222 may include asingle device or a pair of devices such as a pair of left and righthearing aids or tinnitus-maskers. Communication link 220 may include awired link or a wireless link. In one embodiment, communication link 220includes a Bluetooth wireless connection.

Programmer 212 allows for programming of hearing assistance device 222.In various embodiments, programmer 212 may include a computer or othermicroprocessor-based device programmed to function as a programmer forhearing assistance device 222. Examples of such computer or othermicroprocessor-based device include a desktop computer, a laptopcomputer, a tablet computer, a handheld computer, and a cell phone suchas a smartphone. Programmer 212 includes a user interface 202, aprocessing circuit 214, and a communication circuit 224. User interface202 represents an embodiment of user interface 102. In variousembodiments, user interface 202 includes a presentation device includingat least a display screen and an input device. In various embodiments,the presentation device may also include various audial and/or visualindicators, and the user input device may include a computer mouse, atouchpad, a trackball, a joystick, a keyboard, and/or a keypad. In oneembodiment, user interface 202 includes an interactive screen such as atouchscreen functioning as both the presentation device and the inputdevice. Communication circuit 224 allows signals to be transmitted toand from hearing assistance device 222 via communication link 220.Hearing assistance device 222 includes a processing circuit 216 and acommunication circuit 226. Communication circuit 226 allows signals tobe transmitted to and from programmer 212 via communication link 220.

In general, previous tinnitus masking stimuli include a broadband noisewith a flat spectrum and an overall level set to 10 dB (for closed fits)or 20 dB (for open fits) above the patient's average pure-tone hearingthreshold (across 500, 1000, and 4000 Hz) in dB SPL. In addition, thepatient can alter the overall level and spectral shape of the stimulususing. One shortcoming of this approach is that there is currently noautomated procedure in for checking that the selected tinnitus noisedoes not interfere substantially with speech intelligibility. In oneexample, with pure-tone thresholds at 500, 1000, and 4000 Hz in atinnitus patient are as follows: 25, 35, and 80 dB HL. The averagepure-tone threshold across these three frequencies corresponds toapproximately 47 dB SPL. Accordingly, the overall level of the tinnitusmasker will be set to 57 dB SPL for a closed fit. This corresponds to aper-band level of approximately 45 dB SPL. Even when taking into accountthe amplification of the speech signal applied by the hearing-aid, thelevel of the resulting tinnitus masker exceeds the level of a normalconversational speech signal (approximately 65 to 70 dB SPL), especiallyat low frequencies (below 2-3 kHz), which are critically important forgood speech intelligibility.

FIG. 3 illustrates a table showing levels of tinnitus masking and speechat select frequencies, according to various embodiments of the presentsubject matter. Per-band levels of a 65 dB SPL speech signal (afterhearing-aid amplification) and of the tinnitus stimulus in criticalbands with center frequencies of 500, 1000, and 2000 Hz, respectively.The levels per band of the normal speech signal are taken from Table 1of ANSI S3.5-2007. As shown in the present example, the present subjectmatter verifies that the tinnitus stimulus generated by a hearing aid orsome other tinnitus-sound generator does not interfere with speechaudibility and intelligibility. The difference in tinnitus stimuluslevel and normal speech level is shown to increase at increasingfrequencies, in various embodiments.

While clinicians can perform such verification themselves, either byperforming the same calculations as above or by checking that thepatient can still understand speech well when the tinnitus stimulus isplaying, and patients may adjust the level of the tinnitus stimulus toavoid speech-understanding difficulties, neither of these two solutionsis satisfactory—clinicians have drastic time constraints, and patientscannot be trusted to optimally adjust the volume of their tinnitussound.

Various embodiments of the present subject matter can be part of atinnitus-stimulus fitting software. In addition, the present subjectmatter can be used on its own, or as part of a tinnitus-masker fittingprocedure. The present subject matter serves to enhance tinnitus-fittingsoftware and leads to a better solution for the automatic generation oftinnitus stimulus.

FIG. 4 illustrates a flow diagram of a method for fitting atinnitus-masker for a patient, according to various embodiments of thepresent subject matter. The method includes using a speechintelligibility model to predict impact of therapy provided by thetinnitus-maker device on speech understanding of the patient, 402. Aparameter of the tinnitus-masker device is adjusted during fitting toreduce the impact of the therapy provided by the tinnitus-maker deviceon speech understanding of the patient, 404, according to variousembodiments. The present subject matter includes a non-transitorycomputer readable medium to store instructions including the method, anda processor to perform the instructions, in various embodiments.

According to various embodiments, adjusting a parameter of thetinnitus-masker device includes adjusting volume, spectral shape, ormodulation rate of an output of the tinnitus-masker device. The methodfurther comprises using the speech intelligibility model to computeadjustments of the parameters of the tinnitus-masker device duringfitting, in various embodiments. In one embodiment, using a speechintelligibility model to predict impact of therapy provided by thetinnitus-maker device on speech understanding of the patient includesusing a proficiency factor incorporating a relationship between computedaudibility of speech signals and predicted speech intelligibility.Various embodiments include estimating audibility of conversationalspeech in different frequency bands. The method includes using theestimated audibility of conversational speech to compute speechintelligibility scores with and without the therapy provided by thetinnitus-masker device, in an embodiment. In various embodiments, thepresent description relates to computing a corrected speechintelligibility score using a measured or estimated proficiency factorof the patient. The method includes comparing the corrected speechintelligibility score to a predefined threshold, and providing an optionto a user to adjust the parameter of the tinnitus-masker device if thethreshold is exceeded, in an embodiment.

FIG. 5 illustrates a flow diagram of a method for automated assessmentand adjustment of tinnitus-masker impact on speech intelligibilityduring fitting, according to various embodiments of the present subjectmatter. A speech intelligibility model is used to compute a first speechintelligibility score for speech without a tinnitus masking therapyprovided by the tinnitus masking hearing device, 505. The speechintelligibility model is used to compute a second speech intelligibilityscore for speech with the tinnitus masking therapy provided by thetinnitus masking hearing device, 510. A difference is computed betweenthe first speech intelligibility score and the second speechintelligibility score, 515. If the difference exceeds a programmablethreshold, a parameter of the tinnitus-masker device is adjusted toreduce the impact of the therapy provided by the tinnitus-maker deviceon speech understanding of the patient, 520, in various embodiments. Thepresent subject matter includes a non-transitory computer readablemedium to store instructions including the method, and a processor toperform the instructions, in various embodiments.

According to various embodiments, adjusting a parameter of thetinnitus-masker device includes providing an option to a user of thefitting device to adjust the parameter of the tinnitus-masker device.Adjusting a parameter of the tinnitus-masker device includesautomatically adjusting the parameter of the tinnitus-masker device, invarious embodiments. The method includes using an audiogram of thepatient to compute at least one of the first and second speechintelligibility score, in an embodiment. In one embodiment, the firstand second speech intelligibility scores are computed at approximately65 to 70 dB for normal conversational speech level. Adjusting aparameter of the tinnitus-masker device includes adjusting volume,spectral shape and/or modulation rate of an output of thetinnitus-masker device, in various embodiments.

Adjustment During Use

The present subject matter includes automated assessment and adjustmentof tinnitus-masker impact on speech intelligibility during use of thehearing device. In the present subject matter, the speech-model-basedalgorithm is combined with a computational scene-analysis algorithm, andpotentially other measures (e.g., measures of brain activity) to allowfor automatic readjustment of the masker volume and spectralcharacteristics of the therapeutic sound (TS) whenever needed while theuser is wearing the device.

The above method is aimed at facilitating the selection or theadjustment by the clinician, at the time of fitting, of the overallvolume and/or spectrum of the TS, while controlling for expected maskingof speech by the TS, on average (based on expected, long-term averagespeech levels). However, the level of speech in the listener'senvironment can fluctuate over time, depending on factors such as thedistance and vocal effort of the talker. In addition, in some cases(e.g., patients with highly elevated hearing thresholds in frequencyregions that contain important speech information) the highest volume ofthe TS that does not interfere with the perception of speech at aconversational level, is lower than the level needed for the TS to haveits expected effect on tinnitus (e.g., masking). In such cases, it isimpossible to fix the volume of the TS in such a way that it acts asintended, while not interfering with speech.

The present subject matter addresses these limitations by using analgorithm embedded on the device (hearing aid or other TS-generatingdevice) to automatically readjust the volume and/or spectrum of the TSover time, depending on current listening conditions. The adaptation tocurrent conditions is achieved using automatic analysis of thelistener's acoustic environment (e.g., is there a speech signal in theenvironment?) as well as, potentially, information concerning thelistener's current intentions (e.g., is the listener currently trying tolisten to the speech signal?).

According to various embodiments, the present subject matter monitorssound incoming into a device to decide whether speech is present, andwhether external noise is present. If speech is detected, the deviceestimates the level of the speech signal and possibly other measures,such as modulation characteristics, which can be used to estimatewhether the speech signal is accompanied by other signals or noise, whatthe signal-to-noise ratio of the speech signal is, as well as otheracoustic or psychoacoustic variables that can be used advantageously insubsequent adjustment of the TS. The present subject matter uses a modelof speech intelligibility to estimate the impact of the TS on theperception of the speech signal by the user, and the estimated impact isused, if necessary, to readjust the level and/or spectrum of the TS, soas to reduce the impact to a predefined acceptable level.

In an alternate embodiment, the present subject matter additionallymeasures, or estimates, the listener's intent (e.g., using body or brainsignals to infer whether the listener is listening to one of speechsignals in the environment or not). This additional information is thenused to modulate the adjustment of the TS level or spectrum (e.g., ifthe listener is not trying to listen to speech signals around him/her,then there may not be a need to lower the volume of the TS).

FIG. 6 illustrates a block diagram of system for limitingtinnitus-masker impact on speech intelligibility during use of thetinnitus-masker, according to various embodiments of the present subjectmatter.

The current, or ‘reference’, spectrum 602 of the TS is used as input,along with the patient's audiogram 604 and a measure 612 of the currentlevel of speech in the environment (which may equal a very low valuewhen no speech is detected), to a speech-audibility estimation model606. Based on the results, speech-intelligibility scores 608 arecomputed with, and without, the tinnitus masker, using aspeech-intelligibility model. If the speech-intelligibility score 608(or the speech audibility) with the masker is too low, taking intoaccount the speech-intelligibility score without the masker, the overallvolume and spectrum 610 of the TS is readjusted to limit its impact onspeech intelligibility to a predefined acceptable level.

The mathematical description of the present subject matter is closelyaligned with the fitting embodiment. The main difference is that, in theinitial step in the companion invention, the computation of theaudibility of the speech signal, A[f], is based, not on the assumednormal conversational level of speech (65 dB SPL), but on the currentlevel of speech, measured using the device.

In an alternate embodiment of the present subject matter, body or brainsignals (e.g., EEG signals) are additionally used to make an inferenceconcerning the listener's intent 614, e.g., his/her attentional goals.For instance, if speech has been detected in the listener's environment,but the listener is not currently listening to the speech (which can, intheory, be inferred using EEG signals from the listener's brain or fromhis/her eye movements, as may be the case if the listener is currentlyreading), the adjustment of the overall volume and/or spectrum of themasker may be deferred.

While the above embodiment was limited to the time of fitting of thedevice (hearing-aid or other), using an algorithm inside the fittingsoftware, the present subject matter is intended to run constantly, orperiodically, on the device, so that it can reside on hardware(integrated circuit) or firmware (algorithm running on the device). Inthe fitting embodiment, the computation of the speech-masking effect ofthe TS was performed with respect to a fixed and assumed, long-termaverage speech level (e.g., 65 dB SPL). In the present embodiment, thepresence and level of speech is actually measured (or estimated) in thelistener's environment, while the listener is using the device, and thelevel and/or spectrum of the TS is readjusted, whenever necessary, frommoment to moment. According to various embodiments, this subject matteris as part of a hearing assistance device, which also generates a TS fortinnitus. Alternatively, the present subject matter can be put on atinnitus-masking device that is not a hearing aid.

FIG. 7 illustrates a flow diagram of a method for automated assessmentand adjustment of tinnitus-masker impact on speech intelligibilityduring use, according to various embodiments of the present subjectmatter. The method includes using a speech intelligibility model topredict impact of therapy provided by the tinnitus-maker device onspeech understanding of the patient 702, and automatically adjusting aparameter of the tinnitus-masker device during use of the device toreduce the impact of the therapy provided by the tinnitus-maker deviceon speech understanding of the patient 704.

Hearing assistance devices typically include at least one enclosure orhousing, a microphone, hearing assistance device electronics includingprocessing electronics, and a speaker or “receiver.” Hearing assistancedevices can include a power source, such as a battery. In variousembodiments, the battery is rechargeable. In various embodimentsmultiple energy sources are employed. It is understood that in variousembodiments the microphone is optional. It is understood that in variousembodiments the receiver is optional. It is understood that variationsin communications protocols, antenna configurations, and combinations ofcomponents can be employed without departing from the scope of thepresent subject matter. Antenna configurations can vary and can beincluded within an enclosure for the electronics or be external to anenclosure for the electronics. Thus, the examples set forth herein areintended to be demonstrative and not a limiting or exhaustive depictionof variations.

It is understood that digital hearing assistance devices include aprocessor. In digital hearing assistance devices with a processor,programmable gains can be employed to adjust the hearing assistancedevice output to a wearer's particular hearing impairment. The processorcan be a digital signal processor (DSP), microprocessor,microcontroller, other digital logic, or combinations thereof. Theprocessing can be done by a single processor, or can be distributed overdifferent devices. The processing of signals referenced in thisapplication can be performed using the processor or over differentdevices. Processing can be done in the digital domain, the analogdomain, or combinations thereof. Processing can be done using subbandprocessing techniques. Processing can be done using frequency domain ortime domain approaches. Some processing can involve both frequency andtime domain aspects. For brevity, in some examples drawings can omitcertain blocks that perform frequency synthesis, frequency analysis,analog-to-digital conversion, digital-to-analog conversion,amplification, buffering, and certain types of filtering and processing.In various embodiments of the present subject matter the processor isadapted to perform instructions stored in one or more memories, whichcan or cannot be explicitly shown. Various types of memory can be used,including volatile and nonvolatile forms of memory. In variousembodiments, the processor or other processing devices executeinstructions to perform a number of signal processing tasks. Suchembodiments can include analog components in communication with theprocessor to perform signal processing tasks, such as sound reception bya microphone, or playing of sound using a receiver (i.e., inapplications where such transducers are used). In various embodiments ofthe present subject matter, different realizations of the blockdiagrams, circuits, and processes set forth herein can be created by oneof skill in the art without departing from the scope of the presentsubject matter.

It is further understood that different hearing assistance devices canembody the present subject matter without departing from the scope ofthe present disclosure. The devices depicted in the figures are intendedto demonstrate the subject matter, but not necessarily in a limited,exhaustive, or exclusive sense. It is also understood that the presentsubject matter can be used with a device designed for use in the rightear or the left ear or both ears of the wearer.

The present subject matter is demonstrated for hearing assistancedevices, including hearing assistance devices, including but not limitedto, behind-the-ear (BTE), in-the-ear (ITE), in-the-canal (ITC),receiver-in-canal (RIC), invisible-in-canal (IIC) orcompletely-in-the-canal (CIC) type hearing assistance devices. It isunderstood that behind-the-ear type hearing assistance devices caninclude devices that reside substantially behind the ear or over theear. Such devices can include hearing assistance devices with receiversassociated with the electronics portion of the behind-the-ear device, orhearing assistance devices of the type having receivers in the ear canalof the user, including but not limited to receiver-in-canal (RIC) orreceiver-in-the-ear (RITE) designs. The present subject matter can alsobe used in hearing assistance devices generally, such as cochlearimplant type hearing devices. The present subject matter can also beused in deep insertion devices having a transducer, such as a receiveror microphone. The present subject matter can be used in devices whethersuch devices are standard or custom fit and whether they provide an openor an occlusive design. It is understood that other hearing assistancedevices not expressly stated herein can be used in conjunction with thepresent subject matter.

This application is intended to cover adaptations or variations of thepresent subject matter. It is to be understood that the abovedescription is intended to be illustrative, and not restrictive. Thescope of the present subject matter should be determined with referenceto the appended claims, along with the full scope of legal equivalentsto which such claims are entitled.

What is claimed is:
 1. A method of using a tinnitus-masker device for apatient, the method comprising: using a speech intelligibility model topredict impact of therapy provided by the tinnitus-maker device onspeech understanding of the patient; and automatically adjusting aparameter of the tinnitus-masker device during use of the device toreduce the impact of the therapy provided by the tinnitus-maker deviceon speech understanding of the patient.
 2. The method of claim 1,wherein adjusting a parameter of the tinnitus-masker device includesadjusting volume, spectral shape, or modulation rate of an output of thetinnitus-masker device.
 3. The method of claim 1, comprising using thespeech intelligibility model to compute adjustments of the parameters ofthe tinnitus-masker device during use.
 4. The method of claim 1, whereinusing a speech intelligibility model to predict impact of therapyprovided by the tinnitus-maker device on speech understanding of thepatient includes using a proficiency factor incorporating a relationshipbetween computed audibility of speech signals and predicted speechintelligibility.
 5. The method of claim 1, wherein using a speechintelligibility model to predict impact of therapy provided by thetinnitus-maker device on speech understanding of the patient includesestimating audibility of conversational speech in different frequencybands.
 6. The method of claim 5, comprising using the estimatedaudibility of conversational speech to compute speech intelligibilityscores with and without the therapy provided by the tinnitus-maskerdevice.
 7. The method of claim 1, comprising computing a correctedspeech intelligibility score using a measured or estimated proficiencyfactor of the patient.
 8. The method of claim 7, comprising comparingthe corrected speech intelligibility score to a predefined threshold,and providing an option to a user to adjust the parameter of thetinnitus-masker device if the threshold is exceeded.
 9. A tinnitusmasking hearing device for a patient, the device comprising: a soundgenerator configured to provide tinnitus masking therapy; and aprocessor connected to the sound generator, the processor programmedwith instructions to perform: using a speech intelligibility model tocompute a first speech intelligibility score for speech without atinnitus masking therapy provided by the tinnitus masking hearingdevice; using the speech intelligibility model to compute a secondspeech intelligibility score for speech with the tinnitus maskingtherapy provided by the tinnitus masking hearing device; computing adifference between the first speech intelligibility score and the secondspeech intelligibility score; and if the difference exceeds aprogrammable threshold, adjusting a parameter of the tinnitus-maskerdevice to reduce the impact of the therapy provided by thetinnitus-maker device on speech understanding of the patient.
 10. Thedevice of claim 9, wherein adjusting a parameter of the tinnitus-maskerdevice includes providing an option to a user of the device to adjustthe parameter of the tinnitus-masker device.
 11. The fitting device ofclaim 9, wherein adjusting a parameter of the tinnitus-masker deviceincludes automatically adjusting the parameter of the tinnitus-maskerdevice.
 12. The fitting device of claim 9, wherein the processor isfurther configured with instructions to perform: using an audiogram ofthe patient to compute at least one of the first and second speechintelligibility score.
 13. The fitting device of claim 9, wherein thefirst and second speech intelligibility scores are computed atapproximately 65 to 70 dB for normal conversational speech level. 14.The fitting device of claim 9, wherein adjusting a parameter of thetinnitus-masker device includes adjusting volume of an output of thetinnitus-masker device.
 15. The fitting device of claim 9, whereinadjusting a parameter of the tinnitus-masker device includes adjustingspectral shape of an output of the tinnitus-masker device.
 16. Thefitting device of claim 9, wherein adjusting a parameter of thetinnitus-masker device includes adjusting modulation rate of an outputof the tinnitus-masker device.
 17. A non-transitory computer-readablestorage medium that stores instructions for execution by processingcircuitry of a tinnitus masking hearing device for a patient, theoperations including: using a speech intelligibility model to compute afirst speech intelligibility score for speech without a tinnitus maskingtherapy provided by the tinnitus masking hearing device; using thespeech intelligibility model to compute a second speech intelligibilityscore for speech with the tinnitus masking therapy provided by thetinnitus masking hearing device; computing a difference between thefirst speech intelligibility score and the second speech intelligibilityscore; and if the difference exceeds a programmable threshold, adjustinga parameter of the tinnitus-masker device to reduce the impact of thetherapy provided by the tinnitus-maker device on speech understanding ofthe patient.
 18. The computer-readable storage medium of claim 17,wherein adjusting a parameter of the tinnitus-masker device includesadjusting volume of an output of the tinnitus-masker device.
 19. Thecomputer-readable storage medium of claim 17, wherein adjusting aparameter of the tinnitus-masker device includes adjusting spectralshape of an output of the tinnitus-masker device.
 20. Thecomputer-readable storage medium of claim 17, wherein adjusting aparameter of the tinnitus-masker device includes adjusting modulationrate of an output of the tinnitus-masker device.